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Cited by 152Drug-Induced Adverse ReactionsAntibiotic Use and ResistancePharmacovigilance and Adverse Drug Reactions

A proactive approach to penicillin allergy testing in hospitalized patients.

Chen, Justin R., Tarver, Scott A., Alvarez, Kristin S., Tran, Trang, Khan, David A.·2017·The Journal of Allergy and Clinical Immunology In Practice
DOI 10.1016/j.jaip.2016.09.045
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Abstract

Background Penicillin allergy testing is underutilized in inpatients despite its potential to immediately impact antibiotic treatment. Although most tested patients are able to tolerate penicillin, limited availability and awareness of this tool leads to the use of costly and harmful substitutes.Objective We established an inpatient service at a large academic hospital to identify and test patients with a history of penicillin allergy with the goals of removing inaccurate diagnoses, reducing the use of beta-lactam alternatives, and educating patients and clinicians about the procedure.Methods Eligible inpatients were flagged daily through the electronic medical record and prioritized via a specialized algorithm. A trained clinical pharmacist performed penicillin skin tests and challenges preemptively or by provider request. Clinical characteristics and antibiotic use were analyzed in tested patients.Results A total of 1203 applicable charts were detected by our system leading to 252 direct evaluations over 18 months. Overall, 228 subjects (90.5%) had their penicillin allergy removed. Of these, 223 were cleared via testing and 5 by discovery of prior penicillin tolerance. Among patients testing negative, 85 (38%) subsequently received beta-lactams, preventing 504 inpatient days and 648 outpatient days on alternative agents.Conclusions Penicillin allergy testing using a physician-pharmacist team model effectively removes reported allergies in hospitalized patients. The electronic medical record is a valuable asset for locating and stratifying individuals who benefit most from intervention. Proactive testing substantially reduces unnecessary inpatient and outpatient use of beta-lactam alternatives that may otherwise go unaddressed.

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Crossref · 10.1016/j.jaip.2016.09.045

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  • Penicillin skin testing has become a clinically significant element in antibiotic stewardship programs, and the procedure has been increasingly used by hospital-based pharmacists, hospitalists, and infectious disease physicians as part of overall antibiotic stewardship interventions.

    “Penicillin skin testing has become a clinically significant element in antibiotic stewardship programs, and the procedure has been increasingly used by hospital-based pharmacists, hospitalists, and infectious disease physicians (670,672,673,678,679) as part of overall antibiotic stewardship interventions.”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [672]

  • In hospitalized patients and other populations with comorbidities, the typical rates of validated penicillin allergy among patients who report a history of penicillin allergy are 2.5%-9.0%.

    “In hospitalized patients and other populations with comorbidities, the typical rates of validated penicillin allergy among patients who report a history of penicillin allergy are 2.5%–9.0% (670–673).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [672]

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Authors
Chen, J. R., Tarver, S. A., Alvarez, K. S., Tran, T., & Khan, D. A.
Affiliations
  • The University of Texas Southwestern Medical Center (US)
  • Parkland Health & Hospital System (US)
Corresponding author
Khan, David A.
ORCID
Venue
The Journal of Allergy and Clinical Immunology In Practice
Publisher
Elsevier BV
Published
2017-05
Volume
5
Issue
3
Pages
686-693
ISSN
2213-2198 (ISSN-L)
DOI
10.1016/j.jaip.2016.09.045
OpenAlex
W2553633947
Cited by
152
References
31
Citations by year
2026: 1 · 2025: 14 · 2024: 10 · 2023: 11 · 2022: 16 · 2021: 20 · 2020: 15 · 2019: 26 · 2018: 21 · 2017: 16
FWCI
17.01
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Journal of Allergy and Clinical Immunology In Practice (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords
penicillin allergy testing, penicillin skin testing, antibiotic stewardship, clinical pharmacists, hospitalized patients
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Allergens, Drug Hypersensitivity, Female, Humans, Inpatients, Male, Mass Screening, Medical History Taking, Middle Aged, Patient Education as Topic, Penicillins, Pharmacists, Physicians, Skin Tests, Young Adult, Electronic Health Records, Self Report

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